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Comorbid disorders

Addictological and psychiatric comorbidity

Definition and epidemiology of comorbid disorders

Patients with alcohol-related problems frequently experience mental health problems at the same time. The World Health Organization defines the problem of psychiatric comorbidities as the co-occurrence in the same person of a disorder due to the consumption of a psychoactive substance and another psychiatric disorder. In the case of alcohol, a study has shown that 50 to 70% of people who suffer from alcohol dependence at the same time suffer from major psychiatric disorders.
In general, patients with a comorbidity between addictive disorder and mental disorder are at risk of not being diagnosed for one of the two conditions.

Comorbid disorders - the figures

According to current data, it is estimated that 20% to 50% of patients suffering from schizophrenia are addicted to alcohol.
Likewise, an estimated 30% of PTSD patient are part of the alcohol dependent population, which is four times the frequency of this disorder in the general population.

Finally, there are twenty times more abuse of other addictive substances among people addicted to alcohol than in the general population. Among alcohol addicts, 5% are addicted to another substance (2.5% cannabis, 1.5% cocaine and 1% heroin).

Risk factors for co-morbid disorders

Few reliable data allow affirming the link between a psychiatric disorder and an addictive problem. The most commonly used and not mutually exclusive interaction models are:

  • a common factor between the two problems

  • a psychiatric problem secondary to addiction

  • a secondary addiction to the psychiatric problem (hypothesis of hypersensitivity or self-medication)

  • a circular relationship, the two disorders influence each other.

Recent research suggests that there are common factors at work in the co-morbidity between alcohol and mood disorders, generalized anxiety, and antisocial personality disorder.

Treatments and support for co-morbid disorders

Offers specific to dual diagnosis?

Certain therapeutic approaches offer group programs adapted to foster community support in a doubly stigmatized population and, as a result, improve adherence to treatment, addictive results and quality of life for patients.

Integration, communication, centralization

Other than that, there is little solid scientific evidence to recommend a specific treatment for people with alcohol dependence and psychiatric comorbidity.

However, a broad consensus of experts recommends an integrated treatment of the two problems. In the case of parallel treatments by several specialists, the recommendation is to integrate the information and coordinate the treatment plan by close communication between the professionals, by designating a case manager, the central point of contact for the patient and the healthcare network.

In addition, depending on psychiatric pathologies, it is also important to adapt the treatment plan to the patient’s cognitive, relational and self-management capacities, and in some cases to call on those around them to support certain disabilities.

Drug treatments

Medically, no solid scientific data is strongly recommendable. Aside from the controversy surrounding the administration of benzodiazepines for anxiety disorders and alcohol dependence, the recommendations are to treat both conditions in parallel with usual treatments, taking into account the pharmacological interactions between drugs and alcohol.